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目的 :比较全乳野中野正向调强放疗(FP-FIF-IMRT)技术和逆向调强放疗(IP-IMRT)技术在乳腺癌保乳术后病人正常组织的剂量分布差异。方法:回顾性分析2016年1月至7月乳腺癌保乳术后病人,以调强技术行全乳放疗,并分层抽样。全乳处方剂量为50 Gy/25次,后续瘤床加量10 Gy/5次。在定位CT片上对抽样病人全心和患侧肺进行勾画,并在ADAC Pinnacle系统上收集心肺剂量-体积参数。结果:左乳FP-FIF-IMRT组和IP-IMRT组分别有33例和15例,右乳分别有23例和17例。与IP-IMRT组相比,左侧乳腺癌病人FP-FIF-IMRT组心脏V2、V5参数平均值均较低(P<0.05),但心脏V40则略高(分别为4.31%±2.47%比2.39%±1.74%,P=0.009 5)。右侧乳腺癌病人心脏平均剂量及V2、V5、V10也均较低(P<0.05)。与IP-IMRT组相比,左、右侧乳腺癌病人FP-FIF-IMRT组患侧肺平均剂量及V5、V10、V20均较低(P<0.05)。结论:乳腺癌保乳术后放疗中,与IP-IMRT技术相比,FP-FIF-IMRT技术降低正常组织低剂量照射区体积,但IP-IMRT在限制心脏高剂量区体积方面表现更佳。
OBJECTIVE: To compare the dose distribution of normal tissue after breast-conserving surgery in breast-cancer patients by FP-FIF-IMRT and IP-IMRT. Methods: A retrospective analysis of patients after breast conserving surgery from January to July 2016 was performed with whole-breast radiotherapy with intensity-modulated technique and stratified sampling. The prescription dose of whole milk was 50 Gy / 25 times and the subsequent bed volume was 10 Gy / 5 times. Patient-centered and diseased lungs were sketched on localized CT slices and cardio-pulmonary dose-volume parameters were collected on the ADAC Pinnacle system. Results: There were 33 cases in the FP-FIF-IMRT group and 15 cases in the IP-IMRT group, and 23 cases in the right breast and 17 cases in the right breast respectively. Compared with the IP-IMRT group, the average values of V2 and V5 parameters in the FP-FIF-IMRT group were lower (P <0.05), but the V40 was slightly higher in the left breast cancer group (4.31% ± 2.47% 2.39% ± 1.74%, P = 0.009 5). The average cardiac dose and V2, V5 and V10 in patients with right breast cancer were also lower (P <0.05). Compared with the IP-IMRT group, the mean lung dose and V5, V10 and V20 in the FP-FIF-IMRT group were lower than those in the IP-IMRT group (P <0.05). Conclusion: Compared with IP-IMRT, FP-FIF-IMRT reduces the volume of low-dose irradiation in normal tissues during radiotherapy after breast-conserving surgery, but IP-IMRT performs better in limiting the volume of high dose area in heart.